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All Journal Sari Pediatri Paediatrica Indonesiana Archives of Pediatric Gastroenterology, Hepatology, and Nutrition
Pramita Gayatri
Department Of Child Health, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta
Health Professions Medicine & Pharmacology

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Profil Lipodistrofi dan Dislipidemia pada Pasien Prepubertas dengan HIV yang Mendapat Terapi ARV di Rumah Sakit Cipto Mangunkusumo Yessi Yuniarti; Aryono Hendarto; Nia Kurniati; Djajadiman Gatot; Pramita Gayatri; Mulya Rahma Karyanti
Sari Pediatri Vol 18, No 1 (2016)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (568.896 KB) | DOI: 10.14238/sp18.1.2016.55-62

Abstract

Latar belakang. Terapi antiretroviral (ARV) kombinasi telah berhasil menurunkan angka morbiditas dan mortalitas pasien HIV, tetapi menimbulkan efek samping jangka panjang berupa sindrom lipodistrofi.Tujuan. Mengidentifikasi adanya lipodistrofi dan dislipidemia pada pasien prepubertas dengan HIV yang mendapatkan terapi ARV jangka panjang.Metode. Penelitian potong lintang dilakukan pada 76 pasien HIV usia prepubertas di Poli Alergi Imunologi RSCM. Pemeriksaan klinis lipodistrofi dilakukan oleh tenaga klinis, tebal lipatan kulit (TLK) triceps dan subscapular, lingkar pinggang serta rasio lingkar pinggang-panggul. Data kadar CD4 awal, status gizi awal terdiagnosis, jenis terapi ARV, dan lama terapi ARV didapatkan dari rekam medis. Subyek juga dilakukan analisis diet, pemeriksaan profil lipid, dan gula darah puasa.Hasil. Subyek prepubertas dengan HIV yang mendapatkan terapi ARV yang mengalami lipodistrofi dan dislipidemia berturut-turut 47% dan 46%. Subyek lipodistrofi berupa lipohipertrofi 35%, lipoatrofi 5%, dan tipe campuran 7%. Mayoritas subyek lipodistrofi memiliki massa lemak tubuh, serta TLK triceps dan subscapular normal. Subyek lipohipertrofi dan tipe campuran seluruhnya memiliki rasio lingkar pinggang-panggul meningkat. Terdapat hubungan yang bermakna antara penggunaan regimen ARV 2NRTI + PI meningkatkan risiko 6,9 kali untuk terjadinya dislipidemia (p=0,001 IK95%: 2,03-23,7) dibandingkan regimen 2NRTI+ NNRTI.Kesimpulan. Prevalensi lipodistrofi dan dislipidemia cukup tinggi pada pasien prepubertas dengan HIV yang mendapatkan terapi ARV. Mayoritas subyek yang mengalami lipodistrofi memiliki massa lemak tubuh, TLK triceps dan subscapular yang normal.
Hubungan antara Kadar High Density Lipoprotein dengan Derajat Sepsis Berdasarkan Skor Pediatric Logistic Organ Dysfunction Emi Yulianti; Antonius H. Pudjiadi; Mardjanis Said; E.M. Dady Suyoko; Hindra Irawan Satari; Pramita Gayatri
Sari Pediatri Vol 15, No 2 (2013)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (217.041 KB) | DOI: 10.14238/sp15.2.2013.116-21

Abstract

Latar belakang. Sepsis masih merupakan penyebab kematian terbesar di Pediatric Intensive Care Unit (PICU). Peran high density lipoprotein(HDL) pada keadaan sepsis mengikat dan menetralisir lipopolisakarida (LPS), menghambat adhesi molekul dalam kaskade inflamasi, dan sebagai antioksidan.Tujuan. Mengetahui profil HDL pada anak sepsis serta mengetahui hubungan kadar HDL dengan derajat sepsis berdasarkan skor pediatric logistic organ dysfunction (PELOD). Metode.Studi potong lintang pada anak sepsis di PICU Rumah Sakit Cipto Mangunkusumo (RSCM) usia 1 bulan- 18 tahun antara April-Agustus 2011.Hasil. Didapatkan 34 subjek, dengan sebaran terbanyak pada kelompok usia <2 tahun (19/34). Terdapat hubungan antara kematian dengan skor PELOD >20 (p=0,000). Lima dari 7 pasien dengan skor PELOD >20 ditemukan mempunyai kadar HDL rendah (p=1). Tidak didapatkan hubungan yang bermakna antara kematian dengan kadar HDL (p=0,248). Terdapat korelasi lemah berbanding terbalik antara kadar HDL dengan skoring PELOD tetapi tidak bermakna secara statistik (r =-0,304, p = 0,080)Kesimpulan. Pasien sepsis dengan skor PELOD tinggi cenderung memiliki kadar HDL rendah.
Faktor - Faktor yang Memengaruhi Terjadinya Laringomalasia pada Anak dengan Penyakit Refluks Gastroesofageal Lina Ninditya; Wahyuni Indawati; Yogi Prawira; Pramita Gayatri
Sari Pediatri Vol 23, No 6 (2022)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp23.6.2022.383-9

Abstract

Latar belakang. Penyakit refluks gastroesofageal (PRGE) merupakan komorbiditas tersering pada pasien dengan laringomalasia. Banyak studi yang sudah membuktikan adanya hubungan antara PRGE dengan laringomalasia. Namun, sejauh ini belum ada studi yang mempelajari faktor-faktor yang memengaruhi terjadinya laringomalasia pada pasien dengan PRGE. Tujuan. Mengetahui proporsi laringomalasia pada anak dengan PRGE dan faktor-faktor yang memengaruhi (prematuritas, orang tua dengan riwayat dispepsia, pola makan dan disfungsi neurologis) terjadinya laringomalasia pada anak dengan PRGE. Metode. Merupakan studi prognostik dengan desain potong lintang pada 88 anak dengan diagnosis PRGE yang diambil dari rekam medis RSCM mulai dari tahun 2017 hingga 2020. Analisis data menggunakan chi-square/Fisher and logistic regression.Hasil. Proporsi laringomalasia didapatkan 12,5%. Tidak ada faktor yang memengaruhi terjadinya laringomalasia pada anak dengan PRGE. Namun, penelitian ini melihat adanya kecenderungan terjadinya laringomalasia pada subyek dengan pajanan asap rokok, adanya asupan makanan/minuman tengah malam, palsi serebral, dan pola makan yang tidak sesuai dengan feeding rule. Kesimpulan. Adanya kecenderungan terjadinya laringomalasia pada subyek dengan pajanan asap rokok, adanya asupan makanan/minuman tengah malam, dan pola makan yang tidak sesuai dengan feeding rule.
Manfaat Pemberian Probiotik pada Diare Akut Diana Rahmi; Pramita Gayatri
Sari Pediatri Vol 17, No 1 (2015)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (65.243 KB) | DOI: 10.14238/sp17.1.2015.76-80

Abstract

Latar belakang. Beberapa penelitian membuktikan bahwa probiotik bermanfaat pada diare akut dan diharapkan dapat mengurangidurasi dan frekuensi diare serta gejala lain seperti demam sera muntahTujuan. Mengevaluasi kegunaan probiotik pada diare akut berdasarkan bukti ilmiahMetode. Penelusuran pustaka database elektronik : Pubmed, Cochrane, Highwire.Hasil. Dua metaanalisis mengenai efek probiotik terhadap diare akut mendapatkan probiotik secara bermakna durasi diare dibandingkankontrol (-0,67; KI 95%, -0,95 sampai -0,38, p<0,00001) dan mean duration diare berkurang bermakna pada kelompok probiotik(86,4 jam) dan 115,2 jam pada kelompok plasebo (p=0,0001). Uji klinis acak tersamar mendapatkan pemberian probiotik single strainmempersingkat durasi diare dibandingkan pada kelompok probiotik multiple strain (p=0.004). Uji klinis acak tersamar menggunakanprobiotik Lactobacilus GG dengan placebo mendapatkan jumlah hari diare kembali ke konsistensi normal lebih singkat pada kelompokprobiotik (p=0,002), tetapi penelitian di India tidak mendapatkan perbedaan bermakna dalam durasi diare.Kesimpulan. Penelitian terhadap efektifitas pemberian probiotik pada diare akut masih beragam meskipun sebagian besar menunjukkanefektifitas dalam menurunkan lama dan frekuensi diare, hal ini mungkin dipengaruhi oleh strain probiotic yang diberikan.
Efficacy of sputum induction from lower respiratory tract in children Madeleine Ramdhani Jasin; Darmawan Budi Setyanto; Sri Rezeki Hadinegoro; Lisnawati Lisnawati; Pramita Gayatri; Nia Kurniati
Paediatrica Indonesiana Vol 55 No 2 (2015): March 2015
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (107.119 KB) | DOI: 10.14238/pi55.2.2015.101-8

Abstract

Background Although sputum is a good specimen for variousexaminations, such as cytology and microbiological culture,sputum induction (SI) is not a routine procedure in children.Objective To identify the efficacy of SI to obtain specimen fromlower respiratory tract in children, identify side effects of SI, andthe results of microbiological examination.Methods A cross sectional study was performed in children (aged1 month to 18 years) who underwent SI. Sputum induction wasperformed by inhalation with hypertonic solution, consisted ofsalbutamol for 15 minutes continued with NaCl 3% solutionfor another 15 minutes. Sputum specimens were examined fornumber of alveolar macrophage cell, surfactant protein A (SP-A)concentration, also acid-fast bacili smear, and M. tuberculosisculture, or aerobic microbial culture.Results Forty subjects with lower respiratory tract infectionparticipated in this study, and SI was succesfully performed inall subjects. Youngest subject was 2 month old, the eldest was 16year 7 month old. Median duration of SI was 45 minutes, andmajority of volume was 3 or 4 mL. Side effects were nosebleeds(40%) and vomiting (2.5%). Macrophage alveolar more than 5cells in one specimen was found in 97.5% subjects. Surfactantprotein A examination was performed in 30 specimens, and SP-Awas detected in all specimens (median concentration 264.528 pg/mL). Culture for M. tuberculosis was positive in 1 of 27 subjects,while acid fast bacili smear was negative in all examined subjects.Aerobic microbial culture was positive in 5 of 13 subjects.Conclusions Sputum induction has good efficacy in obtaininglower respiratory tract specimen and it is safe to perform inchildren. Specimen from sputum induction yields good positiveresult for aerobic microbial cultures.
Efficacy of oral erythromycin to enhance feeding tolerance in preterm infants Made Sukmawati; Rinawati Rohsiswatmo; Rulina Suradi; Pramita Gayatri
Paediatrica Indonesiana Vol 57 No 3 (2017): May 2017
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (117.76 KB) | DOI: 10.14238/pi57.3.2017.154-9

Abstract

Background Feeding intolerance is a common condition that affects preterm infants. Erythromycin is a prokinetic agent used to treat feeding intolerance, but its efficacy remains inconclusive.Objective To evaluate the effectiveness of oral erythromycin to enhance feeding tolerance in preterm infants.Methods This prospective, randomized controlled trial in preterm infants was conducted at Sanglah Hospital, Denpasar, Bali, from June 2015 to January 2016. Eligible infants were randomized to receive either 12.5 mg/kg/dose oral erythromycin or a placebo, every 8 hours. The primary outcome was the time to establish full enteral feeding. The secondary outcomes were body weight at full enteral feeding and length of hospital stay.Results Of 62 initial subjects, 3 infants dropped out of the study. Thirty infants were given erythromycin and 29 infants were given placebo. The baseline characteristics of the two groups were similar, with mean of gestational ages of 31.4 (SD 1.7) weeks in the erythromycin group and 32.4 (SD 2.2) weeks in the placebo group. The median times to reach full enteral feeding did not significantly differ between the two groups, with 10 (SD 5.3) days in the erythromycin group vs. 8 (SD 6.5) days in the placebo group (P=0.345). Also, median body weights at full enteral feeding and lengths of hospital stay were not significantly different between the two groups.Conclusion Erythromycin of 12.5 mg/kg/dose every 8 hours as prophylactic treatment does not significantly enhance feeding tolerance in preterm infants. Median body weights at full enteral feeding and length of hospital stay are not significantly different between the erythromycin and placebo groups.
Risk Factors of Chronic Diarrhea in HIV-Infected Children Satrio W. Fathurrahman; Pramita Gayatri
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 1 No. 1 (2022): APGHN Vol. 1 No. 1 May 2022
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (372.369 KB) | DOI: 10.58427/apghn.1.1.2022.1-8

Abstract

Background. Chronic diarrhea increases mortality and other long-term morbidities in children. HIV-infected children are at higher risk of developing chronic diarrhea. Objective. This study aimed to investigate the characteristics, prevalence, and risk factors of chronic diarrhea in HIV-infected children. Methods. Data were obtained retrospectively from medical records of HIV-infected children at Dr. Cipto Mangunkusumo General Hospital (RSCM) from January 2014 until December 2016. The risk factors evaluated included age, nutritional status, dehydration status, HIV-infection phase, use of antiretroviral (ARV) drugs, and stool culture. All data that fulfilled the inclusion criteria were analyzed by bivariate followed by multivariate analysis, except for stool culture. Results. The prevalence of chronic diarrhea in HIV-infected children in RSCM was 12.98%. Analysis of 132 data showed that chronic diarrhea was significantly associated with low nutritional status (p=0.037; adjusted OR=5.737) and dehydration (p=0.026; adjusted OR=6.891) among HIV-infected children. Conclusion. Dehydration status and malnutrition are important risk factors for chronic diarrhea in HIV-infected children. These findings may also support that in managing HIV-infected children with diarrhea, one should first overcome dehydration and manage malnutrition to prevent the vicious circle of diarrhea – malnutrition – diarrhea.
Virological failure of first-line antiretroviral therapy in children living with HIV in Indonesia and associated factors Nia Kurniati; Zakiudin Munasir; Pramita Gayatri; Evy Yunihastuti; Budiman Bela; Anggraini Alam
Paediatrica Indonesiana Vol 62 No 5 (2022): September 2022
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi62.5.2022.295-303

Abstract

Background The World Health Organization (WHO) recommends viral load (VL) monitoring for HIV patients on antiretroviral therapy (ART). However, availability of VL monitoring in low-income countries remains limited. Objective To investigate factors associated with virological failure in HIV-infected children treated without routine VL monitoring. Methods This cohort study was done in children living with HIV (CLHIV) registered at Cipto Mangunkusumo General Hospital from 2004 to 2021. Viral load monitoring was not routinely done. Subjects with at least one VL result after 6 months on ART were included in the study. Virological failure was defined as a VL of >1,000 copies. Subjects’ data were obtained from medical records, laboratory reports, and dispensing pharmacies. Statistical analysis was done following survival analysis with hazard ratio. Results There were 384 children who had at least 1 VL result after ART was initiated. Median age at diagnosis was 30 months. Length of follow-up ranged from 6 to 216 months, with a mean frequency of VL monitoring of 0.7 times/person/year. Most subjects were already in clinical stages 3 and 4 (77.8%); 75% met severe immunodeficiency criteria. Virological failure was found in 45.8% of subjects after a median of 33 months on first-line ART, yielding an incidence of 3.3 per 1,000 person months. Independent associated factors were age at diagnosis of <60 months (HR 1.714; 95%CI 1.13 to 2.6), severe immunodeficiency (HR 1.71; 95%CI 1.15 to 2.54), referral cases (HR 1.70; 95%CI 1.23 to 2.36), and WHO clinical staging 3 (HR 1.987; 95%CI 0.995 to 3.969) and 4 (HR 2.084; 95%CI 1.034 to 4.201). Subjects with virological failure had lower weight-for-age z-scores [median 1.92; interquartile range (IQR) -3.003 to -0.81] and height-for-age z-scores [median -2.05; IQR -2.902 to -1.04] at the time of failure. Conclusions In HIV-infected children treated without routine VL monitoring, age at diagnosis <60 months, severe immunodeficiency, WHO clinical stage 3 and 4, and referral from other centers were associated with virological failure.
Cholelithiasis Diagnosis and Management in Thalassemia Ervina Luki Damayanti; Pramita Gayatri
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 3 No. 2 (2024): APGHN Vol. 3 No. 2 May 2024
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.3.2.2024.15-25

Abstract

Background: Cholelithiasis, while infrequently found in children, carries a significant risk for those with underlying conditions like thalassemia compared to the general population. This study aimed to described the manifestations of cholelithiasis in thalassemic children. Case: A 12-year-old girl with beta-thalassemia major presented with recurrent right upper quadrant abdominal pain and vomiting. Imaging revealed cholelithiasis and choledocholithiasis. Due to complications related to her thalassemia, she underwent endoscopic retrograde cholangiopancreatography (ERCP) for gallstone removal followed by laparoscopic cholecystectomy. Post-operative management addressed post-ERCP pancreatitis and bleeding concerns. The patient recovered well and is scheduled for follow-up. Discussion: Increased bilirubin production, iron overload, and altered bile properties in beta-thalassemia contribute to cholelithiasis risk. The patient presented with typical symptoms and underwent successful laparoscopic cholecystectomy after initial management with ERCP, which led to post-ERCP pancreatitis. Conclusion: This case underscores the elevated risk of cholelithiasis in thalassemic children and the importance of early diagnosis and intervention for optimal outcomes.
Ocular complications in pediatric nephrotic syndrome treated with corticosteroids L. Toruan, Yulia Margareta; Trihono, Partini Pudjihastuti; Sitorus, Rita Sita; Dwipoerwantoro, Pramita Gayatri
Paediatrica Indonesiana Vol 64 No 1 (2024): January 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.1.2024.1-9

Abstract

Background Posterior subcapsular cataracts (PSC) and raised intraocular pressure (IOP) are the most common ocular complications of oral steroid administration, particularly following long-term use or treatment with high doses. Objective To evaluate the association between cumulative steroid dose and duration of treatment with the occurrence of PSC and raised IOP, as well as its associated factors in children with idiopatic nephrotic syndrome (INS). Methods This cross-sectional study included children aged 4–18 years with INS who received oral steroid therapy for at least six consecutive months. Patients underwent complete eye examinations by an ophthalmologist to evaluate their visual acuity as well as the occurrence of PSC and/or raised IOP. Results Of 92 subjects, 19.6% had PSC, 12% had raised IOP, and one had a best corrected visual acuity (BCVA) of <6/20. The median cumulative steroid dose was 12,161 (range 1,795–81,398) mg and median treatment duration was 23 (range 6–84) months. There were significant positive associations between cumulative steroid dose as well as treatment duration and the occurrence of PSC, with cut-off points of 11,475 mg and 24 months, respectively, as determined by receiver operator characteristic (ROC) curves. Females were four times more likely to have PSC compared to males (PR 4; 95%CI 1.57 to 13.38; P=0.001). Cumulative steroid dose and duration of treatment were not associated with raised IOP. Conclusion Cumulative steroid dose of 11,475 mg or higher and/or duration of steroid therapy of 24 months of more were significantly associated with the occurrence of PSC, but not with raised IOP.
Co-Authors Anggraini Alam Antonius H. Pudjiadi Aryono Hendarto Budiman Bela Diana Rahmi Djajadiman Gatot E.M. Dady Suyoko Emi Yulianti Ervina Luki Damayanti Evy Yunihastuti Hindra Irawan Satari Jasin, Madeleine Ramdhani L. Toruan, Yulia Margareta Lina Ninditya Lisnawati Lisnawati Made Sukmawati Mardjanis Said Mulya Rahma Karyanti, Mulya Rahma Nia Kurniati Nia Kurniati Nia Kurniati Rinawati Rohsiswatmo Rulina Suradi Satrio W. Fathurrahman Setyanto, Darmawan Budi Sitorus, Rita Sita Sri Rezeki Hadinegoro Trihono, Partini Pudjihastuti Wahyuni Indawati Yessi Yuniarti Yogi Prawira Zakiudin Munasir